Do people with artificial joints need antibiotics before a dental visit?

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Question: I had a knee replacement two months ago at a hospital in Ontario and was provided with literature about what to expect and what to do after the surgery. Included in it was a caution to request an antibiotic prescription from my dentist for any dental procedures – including getting my teeth cleaned – for the rest of my life. The hospital literature said that without antibiotics, my new joint could become infected. But when I recently visited my dentist, he said antibiotics weren’t necessary for people with knee or hip implants. Who is right?

Answer: Your dentist is correct, according to the best available scientific evidence. But patients have good reason to be confused because of conflicting messages from different medical and dental associations in recent years.

It’s true our mouths are teeming with bacteria. So, there has long been a concern bacteria might enter the bloodstream during a dental procedure; simply cleaning the teeth can cause the gums to bleed.

It was feared bacteria could travel in the blood to the site of a prosthetic device – such as a knee or hip implant – and lead to an infection. If the infection eroded the bone around the implant, the patient may need another joint replacement operation.

The risk, however, is considered hypothetical, says Dr. Susan Sutherland, chief of dentistry at Sunnybrook Health Sciences Centre. There is no evidence directly linking dental procedures to implant infections.

Even so, many medical experts felt some precautions were needed.

Unfortunately, those good intentions led to a string of public health recommendations that were not grounded in good science.

It’s worthwhile reviewing the history of the various guidelines to see how they may have contributed to public confusion.

Back in 2003, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) issued a joint statement, saying patients should take one dose of antibiotics an hour before dental procedures for the first two years after they received a knee or hip replacement. In Canada, the dental and orthopaedic associations adopted an identical approach.

Then in 2009, the AAOS, without the agreement of ADA, called for even stricter measures, saying joint-implant recipients should use antibiotics before every dental procedure for their rest of their lives.

Yet, at that same period of time, other medical professionals were openly critical of antibiotic prophylaxis – the practice of giving healthy people antibiotics to prevent a potential infection. In fact, the critics warned the overuse of antibiotics was contributing to the emergence of worrisome antibiotic-resistant strains of bacteria – a major public health threat.

So, the American dentists and orthopaedic surgeons decided, once again, to join forces to review the scientific literature. The reviewers found no direct evidence that dental procedures can lead to implant infections. But their final recommendations, published in 2012, were vaguely worded. They seemed to be neither for nor against antibiotic prophylaxis. Surgeons and dentists essentially had to decide for themselves what to recommend to their patients.

“The guidelines were ambiguous and really not helpful,” says Dr. Sutherland, who is the chair the Canadian Dental Association’s (CDA) committee on clinical and scientific affairs.

Indeed, the rather nebulous recommendations from the American groups led Canadian health professionals to chart their own course.

The Canadian Dental Association released last year a position statement that said: “Routine antibiotic prophylaxis is not indicated for dental patients with total joint replacements, nor for patients with orthopedic pins, plates and screws.”

The Canadian Orthopaedic Association (COA) is still in the process of reviewing the scientific literature and coming up with its own guidelines. “I think it is going to take us another year,” says Dennis Jeanes, the COA’s manager of communication and advocacy. But he indicates the COA reviewers will likely produce recommendations that are very similar to those already adopted by their dentistry counterparts.

Let’s recap where we currently stand. Canadian dentists now have clear guidelines from their national organization – and antibiotic prophylaxis is out. Orthopedic surgeons are still waiting for their recommendations, although they are probably headed in the same direction as the dentists.

I hope this helps explain why you received different advice from your dentist and the hospital where you got your new knee.

In the meantime, the scientific case against antibiotic prophylaxis continues to get stronger. One piece of evidence is particularly convincing: the bacteria in the mouth tend to be different than those associated with infections around implants.

“The organisms that are most responsible for early and late stage prosthetic joint infection are Staphylococcus aureus and coagulase-negative staphylococci, both uncommonly found in the oral cavity or outside their usual skin habitat,” according to a paper published in the Journal of Canadian Dental Association by Dr. Andrew Morris and Dr. Sandra Nelson [formerly Sandra Howie], who are researchers at Mount Sinai Hospital in Toronto.

The paper also contains a sobering statistic. Up to a million patients each year receive total joint replacements in the United States alone. (There are more than 93,000 knee and hip replacement operations performed in Canada annually.)

That’s a big number of additional people who would be taking antibiotics unnecessarily every time they had a dental appointment. It actually amounts to 2 tonnes of antibiotics every 6 to 12 months, further fueling the growth of resistance bacteria – without any proven benefit to patients.

“We use so many antibiotics that are absolutely unnecessary,” says Dr. Morris. “It is almost implausible that the benefits can outweigh the costs. Prosthetic joint infections are extremely uncommon while side effects and complications from antibiotics are rather common.”

So you would be well advised to follow the recommendation of your dentist and forgo the antibiotics. “The routine use of antibiotics for prevention [of infection] in healthy patients is not indicated by the evidence,” says Dr. Sutherland.

Enter the debate: reply to an existing comment

148 comments

Linda WilhelmJanuary 31st, 2014 at 8:28 am

I had my first joint replacement in 1998 and now have a total of six , with seven additional fusions that have metal and pins. It was a few years after my first procedure that I was told I should have antibiotics when having dental work done. I have a friend who had a terrible infection in her artificial knee, just the thought of getting one after seeing what she endured terrified me. So even though I had no problems with infections, I began taking the antibiotics, every year my reaction to them worsened. I asked about taking a different one as I couldn’t imagine that everyone, regardless of their weight should take the same dose, mine was 2 huge pills, pre and post dental work. I was told there was nothing else so last year, after being ill for a month from taking the antibiotics, I decided that I would NOT pre and post medicate for dental work. I felt I was fully informed of the risks and the benefits did not outweigh them for me, which considering my friend with the knee infection says a lot about how ill the antibiotics made me. I was comfortable with my decision, but now even more so. Thank you Healthy Debate for publishing this article.

Your comment gives me heart, after a very discouraging experience of planning for, then having to cancel, hip-replacement surgery due to the antibiotics before dental work issue and a personal history of rather recent c. difficile. I couldn’t envision a postop recovery, which would be challenging under normal circumstances, characterized by arguments with dentists about whether or not they would treat me without premedication, as the outdated premedication guidelines seem to predominate at least among the practitioners I’ve seen (and I’m in a major U.S. city).

The fact that you were already noticing adverse GI effects from antibiotics speaks volumes. It leaves one to wonder what scenario would unfold if a patient became unable to take antibiotics due to untoward effects, if not frank c. difficile. Would the dentist then inform the patient that all future dental treatment must be foregone, due to remote risk of a hip infection, and that repeated c. difficile relapses or even “just” severe diarrhea were simply the tradeoffs one must accept for hip replacement?

The “debate” is ridiculous and massively disempowering of patients. Are people told to abstain from driving because they could become maimed in a car crash? Not the greatest analogy, but there are probably a hundred more that are currently eluding me.

With any antibiotic use, it should be given with Lacto basilius, a probiotic. This helps keep the flora in the bowel a good flora. At the hospital where I work, they have given this combo to hopefully to keep c-dif at bay.

I just had a problem after taking Amoxicillin 2000 MG before dental cleaning and it lasted the rest of the day, that I took it. The next day I was fine but called my Gastro Doc and was told to take Over the counter Florajen 3 , which is what you mention on the same day as you take the antibiotic. I’ll be going back to the dentist in 2 weeks and will try this. I have taken Florajen before and it works fine, I have trouble with Colice

Thanks for the excellent article. I wish I were a Canadian rather than a U.S. patient so that I could access the help of the Health Navigator. I just went through the emotionally grueling, anxiety-provoking experience of cancelling a hip-replacement surgery that I’d had planned for many months. The reason was that, only a few weeks from the surgical date, I discovered that both the ortho surgeon and my dentist were going to state that antibiotic premedication would be needed for virtually every dental procedure, including tooth cleanings and novocaine injections, for “lifetime”! Two years post-hip replacement, which has sometimes been the recommendation in the ever-shifting AAOS guidelines, and which is worrisome enough, had gone out the window.

I had c. dificile colitis a year and a half ago due to clindamycin, a wide-spectrum antibiotic (and one that’s popular among dentists). It was given to me for about ten days following a tear-duct surgery. I am at increased risk for future episodes of c. diff. Making matters worse, my dental visits aren’t limited to routine cleanings once a year. I am strongly recommended for three cleanings, and in a typical year at least one other dental issue, sometimes more, will arise, e.g., a cavity or a deteriorated crown that needs replacement. So I would be told to take antibiotic premedication for up to five times for dental work, in addition to for whatever nondental issues might require it.

This pattern of repeated antibiotic prophylaxis within a narrow timeframe is dangerous not only to people like myself with a history of c. difficile but to the general population, as antibiotic resistance is a skyrocketing problem. I felt the ortho dr. and the dentist were both trying to scare me into acquiescing with their recommendation. I do not think either knows firsthand of the terror of a dysenteric infection triggered by an antibiotic that so far has no reliable cure. People who contract c. difficile can become housebound due to incontinence, require major colon surgery, and, not uncommonly, succumb to the infection, especially if they are elderly and frail.

I was dismayed by the reactions I got from doctors each time I raised my fears of a c. difficile recurrence. They ranged from “Your infection was a long time ago” (a year and a half; NOT long, but in any case, duration not relevant) to “What you REALLY have to worry about is … ” [followed by scare story about someone who developed a catastrophic hip infection] to “You may have immunity to c. diff now.” There is no diagnostic test, as of yet, that would predict “immunity,” and even if immunity were present there is no telling for how long it might last. (I got the latter information about immunity directly from CDC.)

Dr. Morris’s statement that “Prosthetic joint infections are extremely uncommon while side effects and complications from antibiotics are rather common” really says it all.

I had a hip replacement Oct 31
It got infected and infected my heart valve
I was in the hospital till Jan 13th
On IV pic line antibiotics
Infection has caused mt bp to require beta blockers
I have been denied dental treatment from where I have been going for years
I have a new patient app for cleaning
I am not saying anything about my surgery
I am asking my primary care dr if I need to take antibiotics

I am very grateful for this information. At the moment I am feeling ill because of a dentist-ordered Cipro dose (on account of hip replacement some years ago.) I am very tired of reading the back-and-forth hemming and hawing statements of the medical profession, both pro-antibiotics and anti-antibiotics for dental procedures. More and more I am thinking that hereafter I shall just have to chance it and not take the antibiotics if I can find a dentist who will treat me regardless. At any rate, thanks for this site.

I toke the antibiotic for a cleaning clindamycin 300mg 2 of them. 6 months apart then temporary appointment for a bridge. Then the tooth in the temporary bridge bothered me again. Made an appointment toke clindamycin 2, and the dentist could not find out why. So he did nothing. Made another appointment taking 2 clindamycin, 300 mg. and the dentist still could not find out why.
Then I got thrush on my tongue. Still have thrush the knee Dr. changed to Erythromycin 250mg 4 tablets. Now I am taking Nystatin mouth wash 10-15 units 4 times a day. Second time for this medicine. Hope this works this time.
Have another appointment for the temporary bridge to find out which tooth is hurting in a few weeks. Don’t know if I should take Erythromycin 250 mgs 4 of them for metal knee again. Or not to take any more antiboitics for metal knee, I am so confused.

My Dr. Insists on me taking Amoxicillin before tooth procedures. Amoxicillin has never,ever agreed with me. Causes extreme diarrhea and moniliasis. I would rather take a Keflex as I did during and after surgery . No problem.

The above comments are somewhat reassuring as my dentist says “No” to antibiotics and my very well respected surgeon says “take antibiotics prior to dental work”. I feel caught in the middle as both are highly qualified in their field. What to do!

I am in the exact confused patient position. My hip replacement surgeon insists I take 2000 mg of Amoxicillin prior to dental work for the rest of my life, since my total hip replacement surgery in 2009. My dentist spent time to inform me about studies and findings from professional organizations that antibiotics are currently NOT indicated (but they will give them to me if I want them.) What to do indeed. I feel fortunate I have not had side effects from meds. I go to the dentist for 2 cleanings per year plus more for any work needed.

I just read your e-mail, 19 months after you wrote it! I was looking for information as my daughter’s father in law has an infection in his knee after a replacement 10 months ago. I’m not sure if he recently had dental treatment. My husband had a hip replacement 6 years ago and we always make sure he has antibiotics before dental treatment as recommended by his surgeon. His dentist says they’re not necessary. We’ll continue with them but I wondered what you decided to do.

I am very grateful for having read the info in this article but am at the same time very frustrated. I had a total hip replacement end of October, and today (just a little over 5 wks later) a filling broke off. My surgeon’s secretary became hysterical because it was within 3 months – and you’re not supposed to have dental work within that period (as if you have control over these things!). My dentist very carefully polished the sharp area and put a temporary filling in without touching the gums or causing any bleeding. The reason she did treat me was because I am on antibiotics right now due to a tiny infection at the tip of my scar. But she too was very cautious and would require the full two years of pre-dental-work antibiotics. I feel very uncomfortable having to swallow preventative antibiotics because an infection *might* happen. How many cases are even documented where there is a proven causal link between one and the other??? Has more research been done on this possible connection since the 2009 article that is cited? Should I be looking for another dentist who does not require this?

I agree CS! I had PKR exactly 6 weeks ago today and after having a filling break 2 days ago I was concerned (the OS spares no words making one worry about infection after a partial or total knee replacement). No one can plan for this type of occurrence!! I spent the afternoon in a dentist office while THEY went back and forth with my ortho surgeon debating this issue. I am completely confused about the correct actions to take to protect my health versus what is fact and what is fiction. My OS recommended every dental visit be “pretreated with antibiotics” for the next 5 years and yet neither myself or my spouse recall hearing a single warning of that prior to, or following, surgery. Action should be take to thoroughly study this issue and implement treatment plans that are acceptable across all health treatment entities!! I keep hearing the current buzzwords “continuity of care” when it pertains to health care but, in practice those buzz words are non-existent.

I had a hip replacement on Dec5 and a week later a crown fell of, luckily at the back and not painful. My dentist is not in favour of prophylactic antibiotics and I’m waiting for my surgeons opinion. I prefer to limit antibiotics to what is necessary. Wish the “experts” could make their minds up

ACCIDENTS: I see a lot of information about taking antibiotics before medical/dental procedures… What do we (joint replacement patients) do when we fall and cut ourselves? I recently went down on the ice, bruised my replaced hip AND had a tooth pierce my face from the inside out. I am healing well but there was a lot of blood and I had no antibiotics on hand. I certainly would not be able to take anything in advance of an accident. What is recommended for accidental cuts, abrasions & wounds? Thanks!

Thank you for this helpful article. I have been informed that there are only 3 antibiotics that I can take during dental treatment. i am allergic to two of them and hesitate to continue to take the 3rd one namely Co-Azithromycin as this one has to be taken for 5 days every time.
I had hip replacement surgery in 2010 and 2011.
My dentist instructed to me to go back to the surgeon but I know that he has recommended the antibiotics route.
I don’t wish to follow his advice. Please do publish more of the research as it becomes available.

Just this week, I was talking to Dr. Susan Sutherland, chief of dentistry at Sunnybrook Health Sciences Centre about this issue. She says that Canadian medical and dental groups are working on common recommendation for joint-replacement patients facing dental work. But it will likely take some time before such a recommendation is released.

My knee surgeon graduated Princeton University, Harvard Medical School, and did a fellowship at the University of Pennsylvania Hospital. He is relatively young and
has won TOP DOCTORS in Philadelphia. He firmly believes that you take amoxicillin
before any dental procedures, especially cleanings.

The demonstrative absence of incidence study-data supporting the use of antibiotics for joint replacement patients, is a good indicator of the low correlation between dental treatment and joint replacement infection.
As a cancer patient already on more than enough RX, I found myself intestinally sickened by the introduction of prophylactic antibiotics.
My new (young) dentist discouraged antibiotic use before his treatment but I followed the advice of the joint replacement surgeon (replacement now more than two years ago) and took 2000mg worth of horse pills before dental treatment.
Recent research papers do not recommend proactive antibiotic use for joint replacement recipients for dental treatment, and I have made the decision to forego their use for any future dental treatment.
One has to consider the rampant influence the pharmaceuticals have on the dispensing of drugs, including antibiotics. We should not ignore the potential affect of pharmaceutical self interest on the promotion of proactive antibiotics, especially in the absence of data drawing a direct link between joint replacement and potential dental treatment-caused infections.

I just had partial knee replacement which has to be redone next month with total. I have a dental cleaning appt the week prior to the second surgery. I hate taking antibiotics, cipro recently made me deathly ill. Dr prescribed because I was ill after returning from Mexico. This was the first time in my life ever taking antibiotics, and I’m 60. The thought of having to take them twice a year before dental cleanings sickens me. It was the surgeon telling me to take them, the dentist doesn’t seem to for them. I’m really torn, I don’t want an infection after going through 2 knee replacement in 3 months….I’m afraid the amoxicillin will make me I’ll too! How mush data is out there with reported infections after dental cleanings? Very little.

I have R.A. and am on immunosuppressant medication. My dentist says NO antibiotics but post Left TKR my surgeon prescribed Amoxicillin 2 gm 1 hrs before dental procedures “for life” due to being immunosupressed. I have had several staph aureus infections requiring IV antibiotics. My mobility is limited & can not risk infection at knee replacement site. What should immunosupressed patients do?

With all due respect, I am certain that you are incorrect and I also believe that when these studies are made, that they are done using people with healthy gums. Most people do not have healthy gums. Maybe this study should say “If you have extremely healthy gums, you do not have to take amoxicillin” That being said – I know at least six people that have had a major problem with MVP. One was scratched by a stray cat and had an infection settle in the valve…required a heart transplant…she died five years later. One involved getting a catheter for dialysis placed in his arm that caused an infection to settle in his mitral valve and ended up with a pig valve replacement.
One 38 yr old in top physical condition involved with continuous dental work and an undiagnosed MPV. According to the Boston MEDICAL EXAMINER. This produced a myxoid degeneration THAT COULD HAVE BEEN CAUSED BY EXTENSIVE DENTAL WORK to settle in the valve and he died. Another was my sons girlfriends uncle…40 yrs old…again extreme dental work and an undiagnosed
MPV. And more recently, my neighbor dropped over at a concert…again…MPV resulted in an infection in the mitral valve.

What are the chances of one person knowing that many people with undiagnosed MVP and
either dying or getting the mitral valve replaced?? I also know a gentleman that again had extreme
dental work done and ended up with an infection in his replaced knee. Now he has to do it all over
again.

What is the big deal about taking amoxicillin? It’s not that you sit there and OD on it.
You take it once or twice a year when getting a cleaning!!!!
If you want to stop people from taking useless drugs or harmful drugs then write an article on
the misuse of and the extreme side effects of statins!!!!!!!!

Well that was about clear as mud. I have Rheumatoid Arthritis and the medication I take comprises my immune system so this needs to be considered by both my dentist and my Rheumtologist. My surgeon recommended to tell my dentist about both of my total knee replacements. I wish everyone could get on the same page. I see as I said a Rheumatologist but I also see a sleep apnea doctor and my GP who treats my high blood pressure and my diabetes. So basically I’m up a creek without a paddle.

I have been taking amoxicillin before dental appointments for four years with no problems. The last time I took the antibiotics, ended up with a c diff infection, became dehydrated and spent four days in the hospital.

I am trying to find out the right protocol for this and so far find many contradictions. I don’t want to go a c diff infection ever again.

I feel for you, Julie. I had a TKR 6 mos. ago, and now need some dental work done. My dentist says it’s not necessary to do the antibiotics. My OS says for sure for the first 6 mos. so, I’m holding off the dental work as long as I can. What a pain in the neck, and very hard to deal with, I hope the Drs. Get together and get on board with their recommendations….soon!!!,

You are correct about the recommendation being the choice of the dentist, but now that you are more than two years passed you hip surgery, you may want to consider this.
The demonstrative absence of incidence study-data supporting the use of antibiotics for joint replacement patients, is a good indicator of the low, if any, correlation between dental treatment and joint replacement infection.
As a cancer patient already on more than enough RX, I found myself intestinally sickened by the introduction of prophylactic antibiotics.
My new (young) dentist discouraged antibiotic use before his treatment but I followed the advice of the joint replacement surgeon (replacement now more than two years ago) and took 2000mg worth of horse pills before dental treatment.
Recent research papers do not recommend proactive antibiotic use for joint replacement recipients for dental treatment, and I have made the decision to forego their use for any future dental treatment.
One has to consider the rampant influence the pharmaceuticals have on the dispensing of drugs, including antibiotics. We should not ignore the potential affect of pharmaceutical self interest on the promotion of proactive antibiotics, especially in the absence of data drawing a direct link between joint replacement and potential dental treatment-caused infections.

I had my hip replacement in March and had a very difficult recovery due to my surgeon dragging his feet getting me into physical therapy. I would never want to go through that again.My surgeon and dentist are both on board with antibiotics, as are other dentists I consulted with.But,either way,I would have insisted on taking them.This isn’t my first rodeo with high doses of antibiotics and I walked away just fine.However,I will not risk infection,another surgery,or even death when all I have to due is take a few pills.

I had a hip replacement 2 years ago. My surgeon says yes an antibiotic everytime I have my teeth cleaned (which is every 6 months). I am a very healthy person, never get the flu and rarely get colds although sometimes I am aware that my body is fighting something off. Gone in a day!
In Feb. 2015 I took an antibiotic for a tooth cleaning. In March I got a cough that went on for at least 6 weeks. I ignored it because I did not want a Doctor to give me another antibiotic. One day it magically went away only to come back in August. Again I did not want to take an antibiotic but I was starting to feel week and tired and it would not go away. I do take probiotics as well. By the time I went to the Doctor, she said that I had pneumonia from listening to my chest. But when the x-rays came back no pneumonia was seen. This is the first time in many years that I have needed an antibiotic and I feel that taking one on a regular basis has comprimised my immune system.
As a matter of fact a research scientist that I know and attended his lecture. He said that everytime you take an antibiotic you weaken your immune system and the next time something comes along you will get sick easier. I believe him and feel that I have just experienced this. My dentist says no antibiotics after 2 years. I think that I will forego it next time. I am scared …..but I am used to good health. I would rather have false teeth than all kinds of health complications. So now I am going to be scared to have my teeth cleaned.

I was to have a hip replacement in a couple of days after waiting some months for it. I was not informed about not having dental work. I had an extraction 3 – 4 weeks ago and am having a filling tomorrow. I rang the Dentist to see if this would mean that I wouldn’t be able to have the operation. Was told to go ahead with the dental work. I decided to ring the hospital and was informed that because I had had a tooth removed a few weeks earlier and was going to have a filling that the surgeon wouldn’t go ahead with the op and am now having to wait until late November, early December. I had not been informed by my hospital in Australia, that I shouldn’t get dental work done prior to the op. I am very disappointed as I cannot walk without my wheelie walker and in pain. I am 83 years old, quite fit and healthy. There is nothing I can do but accept the decision of the Hospital. I just wonder how many people have this op not knowing that they probably shouldn’t. Thank you for your article and will be interested to hear what my Dentist says tomorrow when I attend for the filling.

Hi Barbara. In Canada it is normal practice that the surgery will not be performed unless the teeth have been cleaned and all dental work done. The hospital have to have the written documents to support this. Of course, if you have to have an extraction, they will need to wait until there is no possibility of infection.

I wonder how many prosthetic joint infections Dr. Morris has seen or treated? As an orthopaedic surgeon, they are not pleasant for anyone. Every ounce of prevention is worth pounds of treatment. Are we exchanging one form of treatment with little evidence for another more potentially dangerous form, also with little evidence?

I had a partial knee replacement nine months ago. I was told by my dentist that I needed to take an antibiotic before every dental visit . When I got my prescription from the pharmacy I was told I would have to take this the rest of my life. I am confused as to the need to take it or not take it. What would you recommend I do??Thanks

Hi Patrick. Yes you need to take them about one hour before your appointment. The last thing you want is to get an infection in the joint which would cause much more pain that you had before, and it would take a long time to get better. Better to take the antibiotics than get an infection.

I am in Australia and have just been in hospital for 2 weeks due to my right knee becoming infected after receiving an annual dental checkup without antibiotics. The knee is 3 years old. I am 56 years old.
As a victim (for want of a better word) of a non antibiotic dentist I can certainly tell you that any discomfort or inconvenience of taking antibiotics before dental work is nothing compared to what I have and continue to endure right now. I have a pic line going to my heart feeding penicillin from infuser bottles every 24 hours for the next 6 weeks.
As said elsewhere, eat Lacto basilius yogurt while taking antibiotics. I am certainly doing this right now to help offset my 10,000mg per day (yes much larger dose than 2 huge tablets before and after dental work!) of penicillin.
I am an actual case, not a hypothetical “could happen may happen” as mostly discussed here.
Signs of an infection such as shivering, weakness in the legs as well as strange pains and a high temperature will occur 3 days after the cause. My dental work was on a Saturday lunch time. I was taken to hospital with the above symptoms on the following Tuesday afternoon. I did not put 2 and 2 together, but my specialist (once I did see him a day later) knew what has happened.
Please take my warning. I can tell you, you do not want the 8 weeks I am now experiencing.

This requirement is very confusing. I am 65 years old. I am very active. Most activities I participate in are “safe”, meaning that I would not encounter skin-breaking injuries. However, I kayak, hunt and do yard work. I have scraped, scratched, cut and punctured myself doing these. I had a TKA 4years ago and a THA 2-1/2 years ago. I continue doing all these activities without using antibiotics. Why for routine dental cleaning? I floss every day, sometimes it bleeds. Similar to Libby’s question, what effect can these skin-breaking episodes produce and, other than avoidance, what to do?

hi my name is Brenda. I recently had a totalknee replacement. I am coming along fine. My surgeon recommended that I take an antibiotic (Azithromycin) before any dental work. I am allegice to penicillin. the recommeded dosage is to take 4 pills (250 mg.) 1 hr before having this done. I am concerned that this is too much. Please advise. thank you

It is alway important to let your doctor know if you have any known drug allergies. And it sounds like that’s what you have done.
Azithromycin is an antibiotic that is sometimes prescribed to patients who have an allergy to penicillin.
In terms of the dose, you really have to discuss that matter with the doctor. If you are uncomfortable raising the issue, then talk to a pharmacist.

By the way, many people think they have an allergy to a particular drug – but don’t really.

Just found out I need to have 2 teeth extracted, as they are near the front of my mouth, a flipper needs to be made so this has been scheduled for Tues. Jan. 19 which is just 6 days before my total hip replacement!!! I hope this doesn’t compromise the surgery…I tried to phone my surgeon as soon as I found out but his office was closed on Friday afternoon. According to my dentist, this time-frame is OK. Anyone know for sure whether the Canadian hospital will be fine to go ahead with my surgery? I have been on antibiotics for a week and they’ve extended them for another few days.

Dear Jupiter,
I hope you are well since this reply is late. But I just wanted to share my story with you. I had a RTH done 4 years ago. I was in so much pain and just wanted it over with. I told my surgeon that my mouth was ok, thank God he made me get a check up prior to surgery I was not ok needed several teeth extracted, should of had root canals, and capped to save them which I regret now. But his words to me were if you have surgery with any type of dental infection it would be Catistrophic!! Dental work is so very expensive even with insurance. I hope you had the surgery and are now recovering. And I think that we are all different and some may need antibiotics post op and others not. Listen to your body ask your doctor questions. They work for you, I interviewed doctors before my surgery. Didn’t like the first one but loved the second. Good Luck!

thank you folks! I am a new member of the THR crowd, having undergone the procedure in October, my surgeon, a fantastic fellow, says take antibiotics prior to dentistry procedure, however since my procedure, I have have UTI and pneumonia; took antibiotics bit my GO was not concerned about possible infection attaching to my new hip; if no concern with pneumonia, why with a tooth repair; I will go with the flow and deny antibiotics for my up coming dental procedure. Thank you for sharing this important information;

This article is very enlightening, but I am still confused. The orthopaedic surgeons, dentists and pharmascists are all giving different advice on this matter. The first I heard about it was in my knee class after surgery. It was not noted in my discharge procedures, my dental hygienist was alarmed that I hadn’t mentioned it and stopped the cleaning and consuilted the doctor in charge who said it was up to me if I wanted to proceed. I was alarmed and asked her to FAX my pharmacy. When I went to pick up my antibiotics he told me it was the law that we had to have them an hour before each cleaning, so I took the medication and went back an hour later. Ithink it is important that all 3 of these individuals get together and issue some kind of statement to their patients. I thought the whole thing was overkill, but my pharacist was adament. Most people don’t question theier health care providers about these things and the public needs to know the truth. Are their any statistics available on how many people have actually been infected?

Thank you for this site. Even though a decision is still in the works. The information helped me decide on my dental work. Which was not to worry after two years of hip replacement. But be diligent not to get an infection in the blood of any kind. Also good to see Canada and USA together on this issue as I needed dental treatment while vacationing.

After reading everyone’s comments, I debated whether I should post a reply or just remain quiet. I decided the other side of this discussion should be heard and read. I acquired an infection after my hip operation a few years ago. I am currently going through treatment which will involve four operations on my right hip in total. The pain, isolation, lack of dignity, loss of mobility not to mention six months out of my life and the cost factor that one goes through is something I wouldn’t wish on my worst enemy. I understand that the chances of this happening to the majority of the population is incredibly small. I felt the same way. This was the last thing I thought of when I started having problems soon after my operation. My Drs. never considered that option either – I was the first to acquire an infection on his watch. Very upsetting for all. No one really knows where infections come from and how they happen and why. If there is still a question about a relationship between dental work and prosthesis infection, I would gladly take the antibiotics that might prevent this. As it stands with me now, that’s exactly what I have been and will be doing for the rest of my life. Truth is, once we have foreign objects placed in our bodies we cross to the other side which is the unknown. The medical community doesn’t have the answer to all the questions that arise with these devices and the reaction to bacteria in the body. But, until the answers are clear and concrete, perhaps the occasional use of prophylaxis before dental procedures is a harmless step for peace of mind.

Thank you for this thoughtful and clearly laid out article on the use of antibiotics before Dental procedures. I have been investigating this question since 2011 when I had a TKR. Great to find Sunnybrook Hospital offers this Health information forum.

It seems to me to be common sense that preventive medication for a non-existent condition is an overreaction. I have just finished a second total hip replacement and have had a number of dental procedures without the support of any antibiotics. I did not experience any adverse reactions in connection with the hip surgeries and the dental work. The bacteria in my mouth is still there when I floss ( and possible bleed ) or when I have dental work done. I think that when proper personal dental hygiene is employed normal dental work dose not pose a risk. In conversation with my doctor he stated that the process should be rethought though, when oral surgery is being employed.

Once again I’m in my office, being asked by a dentist to prescribe antibiotics for a patient with a previous total knee replacement. It’s clearly contrary to CDA guidelines and if the dentist has strong feelings she can prescribe anyway.
It feels like a transfer of medical legal risk onto me. The dentist and the orthopod are the ‘experts’, why am I involved at all?
Can’t we settle this once? Every time it costs me 20-30 minutes and the dentist will not proceed without the antibiotic in any case.

Hi,
I had hip replacement the end of January, and need to have my teeth cleaned. my surgeon and dentist are both telling me to take antibiotics before i go. My family doctor says the opposite, because she is more up to date on the latest reports .I trust her judgement more. I really don’t want to take the antibiotics..not sure what I should do?

Thank-you for this informative article. I have been told my surgeon’s receptionist that I should take antibiotics forever before a dental visit, my dentist, the dental school where I go for dental cleaning all echo the same thing.
I’m truly not happy about this. This year, I have been to the dental school 6 times, the dentist once, and the periodontist once and all required doses of antibiotics, particularly the latter prescribed them for 10 days.
I am a healthy 72 year old and have rarely taken antibiotics throughout my life. Now, 2 years after a hip replacement, it seems that my system is flooded with them.
I have recently had a sty in my eye and it seemed a though it wouldn’t heal. My feeling is, that my normal high resistance to such things has been diminished. Even the polysporin eye drops from the drug store had no effect. Garlic juice has been my last resort and seems to have killed the infection.
If the medical profession insists on antibiotics for dental work, I for one will make sure I have the vertical minimum of appointments.

My dentist and my orthopedic doctor insist I take antibiotics pre dental cleaninig. It’s already compromised me. I am limited to a few medications. This is dangerous for me if I truly get an infection of any kind

Because a find some blood at the gum line during a routine brushing, I am assuming that such an opportunity for infection would be equivalent to some bleeding during a cleaning. I have a cleaning appt. one week, a followup uncovering implant appt. the following week and a dental appt. for the cap impression the following week. I am not comfortable taking the prescribed 2000 m. each separate visit. I would take the drug for the most necessary procedure.
Any suggestion?

After 6 years of artificial knees my dentist stopped insisting that I take antibiotics before dental work, In August of 2015, I had my regular cleaning. Dentist noted a small bone fragment had worked its way to gum surface. Told me to come back tomorrow and he would “snip” it off. I did. He snipped. 2 weeks later I awoke with a series of aches, pains and swelling in my left knee. I went to local emerge and after wasting most of my day with all the usual tests (blood, urine, heart rate, etc.)
I was given percoset for the pain and told to go home and manage the pain. Next a.m. I could not get up and my left knee looked like a basketball. We called 911 and asked for ambulance. The medics got me downstairs and into the vehicle. A doctor at Uxbridge Cottage hospital took a fluid sample from the knee and very soon said I had a severe infection of a type of material normally found in the mouth. The ambulance took me to Markham Stouffville hospital where I was immediately rolled into an operating theatre where the doctor removed the implant and put in some kind of spacer. I was placed on an insulin pump which I wore for 4 months. In December I received a new replacement knee and went on therapy & physio for several weeks.
I was told after all this that if I had not gone to emerge when I did. I would not have lived.

I now receive antibiotics 1 hour before any dental work as do all of my dentist’s patients who have some artificial feature.

Well I have dental appointment for cleaning tomorrow. Had knee replacement 3months ago, have 4 amoxicillin
capsules 500 mg each to take one hour before appointment, That’s a lot to take at one time, what’s your thought.

I am due to have aTHR in January and have got a small pocket come up on my gum a the side of a new crown i recently had placed. I feel terrified over having this so close to having my op. As my Orthopedic surgeon insists upon have antibiotics before dental work and has even given me a letter to take to my dentist who does not agree. When i see my dentist about this lump or pocket that has not gone down he may now suggest deep cleaning around this new crown and with so little time before my surgery i feel afraid in case if i am still caring bacteria at the time of the op. The terrible thing is i have actually met another one of my surgeons patients who
Lost her leg due to germs traverling from her teeth to her mental knee following having her teeth cleaned. I feel very unhappy because although my surgeon is one of the top in the country no one is listening and i have met someone who has lost her leg from mouth bacteria after cleaning. Please help me know what to do i am so confused. Thank you

I had a TKR in July and another one 5 weeks ago…have an apt tomorrow for tooth extraction and an implant….have 2000mg of amoxicillin to take…am worried that it is too soon after my last surgery…am very healthy and very chemical free…do not take any meds..have never taken so much med…took some amox last week and left me restless, unable to sleep all. Isn’t and very tired…

Thanks. I a registered nurse , my grand son who is 17yrs has Down Syndrome had heat surgery at age 1year. Five months ago he had a hip replacement. His parents said his cardiologist said he did not need antibiotics. However with some nudging from the dentist started giving it to hi as he had many invasive procedures. I a now leaning toward stopping it after reading this and many other article, including one from American Heart Association? I use and support conventional but lean toward using it wisely. For me holistic and homeopathic is the way to go.

I am in the same boat !! 12 yr old hip replacement and surgeon recommends anti bio the rest of my life, dentist follows surgeon recommendation. Cant blame the medical prof. Medical Malpractice issues make it easier to say “take it forever” My problem is intestinal and no doubt the meds kill “good bacteria” Its up to the patient I guess to roll the dice although it does not appear to be much of a gamble. I am definitely going off for simple dental cleaning. Thanks — JR

Good decision, I believe.
The demonstrative absence of incidence study-data supporting the use of antibiotics for joint replacement patients, is a good indicator of the low correlation between dental treatment and joint replacement infection.
As a cancer patient already on more than enough RX, I found myself intestinally sickened by the introduction of prophylactic antibiotics.
My new (young) dentist discouraged antibiotic use before his treatment but I followed the advice of the joint replacement surgeon (replacement now more than two years ago) and took 2000mg worth of horse pills before dental treatment.
Recent research papers do not recommend proactive antibiotic use for joint replacement recipients prior to dental treatment, and I have made the decision to forego their use for any future dental treatment.
One has to consider the rampant influence the pharmaceuticals have on the dispensing of drugs, including antibiotics. We should not ignore the potential affect of pharmaceutical self interest on the promotion of proactive antibiotics, especially in the absence of data drawing a direct link between joint replacement and potential dental treatment-caused infections.

I had TKA that failed and a TKA revision. About 1 year after, I had a simple dental procedure and was told it wouldn’t require pre-antibiotics. It was the one and only time I didn’t take the antibiotics. Within a couple of months I had a really bad infection in the joint. Couldn’t walk, the pain was unbelievable. Orthopedic specialist put me on 3 antibiotics for about 3 + months to reduce it to a point that he thought I would be okay with. I understand the infection is never fully removed. He basically told me i was lucky to have my leg and be alive. In the pathologist’s report 1 of the bacterias found was also one found in the mouth. If it was not related to that dental appointment, it is an awful big coincidence. It occurred about a year after the revision surgery and the 1 and only time with no pre-antibiotics. I now have little quality of life, as i am left with a leg that is next to useless and chronically painful. It has caused many bad falls. Something as simple as getting off the toilet can be a big deal. Sad that since I was 52 I have lost what life i once knew. Who wants to take that chance? Not me……

This has been helpful but my dentist still insists that due to a hip replacement I must take prophylactic amoxicillin before dental procedures .
Antibiotics set off bouts of diarrhea that make me very reluctant to use a medicine that has no proven link to infection in joint replacement.

I understand and emphathize with your dilemma, however…
The demonstrative absence of incidence study-data supporting the use of antibiotics for joint replacement patients, is a good indicator of the low correlation between dental treatment and joint replacement infection.
As a cancer patient already on more than enough RX, I found myself intestinally sickened by the introduction of prophylactic antibiotics.
My new (young) dentist discouraged antibiotic use before his treatment but I followed the advice of the joint replacement surgeon (replacement now more than two years ago) and took 2000mg worth of horse pills before dental treatment.
Recent research papers do not recommend proactive antibiotic use for joint replacement recipients for dental treatment, and I have made the decision to forego their use for any future dental treatment.
One has to consider the rampant influence the pharmaceuticals have on the dispensing of drugs, including antibiotics. We should not ignore the potential affect of pharmaceutical self interest on the promotion of proactive antibiotics, especially in the absence of data drawing a direct link between joint replacement and potential dental treatment-caused infections.
Wishes for good health.

If the culprit is gum bleeding during a dental procedure, what do people who suffer from gingivitis and therefore bleeding gums do? How should this be addressed as far as the use of antibiotics and prosthetic implants go? Just curious…

I recently (last September) had my hip replaced after a fall. I now need to go to the dentist but I’m apprehensive as I caught C-diff when I was in the hospital. Or maybe I should say that I think I might of had a form of C-diff for a few years. You see I have U.C. and my condition had gotten very bad with what I thought was just my Colitis getting really bad. So now I am very wary of over doing it with antibiotics. I hope you would understand that your opinion would be one of many including my own doctors, thus I hope that you would indeed give your opinion.

My husband had a hip replacement in 2013. He hadn’t been to the dentist in many years and needed to have extensive cleaning over two separate appointments The dentist did not mention taking a antibiotics. His father sees the same dentist and has two joint replacements, one in the past year. The dentist advised him to take the antibiotic before and after. Is it because of his age and health issues?

Leahsswimbabies@bell south.net
I’m taking providence liquid probiotics. I’m having teeth cleaned with a 3 year ago hip replacement. A maturalpathic doctor said it was unnecessary to take antibiotics every time I go to dentist. I put this pro bio. On gums by swishing and bruised and eczema skin u put it on topically. You can only get these from doctors. I dunno what to do tomorrow for my cleaning. Leah erickson

Thank you so much for this. I’m feeling very upset today as my biannual checkup with my dentist was cancelled today because I didn’t take antibiotics (I had a total hip replacement in April). My surgeon insists I take antibiotics before each dental visit for the rest of my life although I’m healthy.My dentist won’t treat me without antibiotics now as the surgeon has the last word. I feel very frustrated and fear the day I need hospital care and end up contracting a super bug. I’m in my mid 70s and seriously thinking of giving up my dental visits altogether. Why are the surgeons so out of step with the newest findings? Thank you for letting me rant

This is all so back and forth, even this year, so very current!
Two shoulder replacements here (11 yrs and 8 yrs), in my sixties and very healthy.
Some say for a year. Others say take for two years. Some feel dental visits need preventative antiobotics for life. Wth? I have researched and studied what these synthetic meds do to the immune system and am not happy. Is there not a way to determine in a blood test which patients may need this measure and which may not? My middle-aged dentist recommended for the rest of my life at today’s cleaning appointment. I am so torn!!

My dentist does not think antibiotics are necessary and my surgeon recommends using antibiotics for life. I would like to give up the antibiotics, especially since the bacteria for hip infections are different than that in the mouth. Since there’s no clear rule can i just stop taking it?

My mother became dangerously ill in the 1980’s with a bacterial infection inthe covering of her heart. She barely survived. At that same time, her friend died of the same kind of infection. Both of them had received knee replacements 5 years prior to their illness. Both of them were told that their deadly illness may have been caused by dental treatments without antibiotic protection.this was theopinion of both their primary care doctors and their surgeons. I have had 2 knee replacements 6 years ago. I am very concerned that my new dentist does not want me to have antibiotics before dental treatments.

i have a L Partial, and possible TKA scheduled for Jan 19, 2018; I had a crown placed on 12/20/2017; My Orthopedic Surgeon has instructions to not have any dental work in the 6 weeks before and after the Knee Surgery. This struck me as an unusually long time. I appreciate the article, as it does seem unnecessary, particularly that far away form the surgery. Thanks for the advice.

odd, my husband just had two knee replacemwnts, and, still (its almost 2018),
the Doctors stated the need for the antibiotics prior to dental work.
They also stated and restated the need to have them with any sign of infection anywhere.

My Wife has been advised that it is necessary to take antibiotics prior to dental work. Her surgeon insists that the problem is the increased risk of infection after dental work and the problem is that the body would normally identify the infection and deal with it using its own defences. The problem is that the the hip (or knee) replacement is not a full functional part of the body and that an infection in the metal joint can develop undetected by the natural body defence system, and as a result the infection can grow without restraint from the body’s natural immune system – he says don’t be stupid enough to take your chances, but if you do good luck because a second replacement of the same joint is worse than just painful – maybe not even possible! Of course if you don’t get an infection no problem – but you are rolling the dice if you don’t take the antibiotics!

yes, my comment is concerning how dental office had to have a signed request from Dr. if he prescribed antibiotics for dental work or not!! when sent to him for my dental care, he said yes, and the office then told me to get a prescription from him! Could not do this cuz Dr. had gone out of my ins. network creating havoc on any timely dental care which was a badly hurting molar!!! Now am told do not need this and am sorry i told anyone of knee surgery at all!!!

I am in the US but caught in bind between my hip replacement surgeon (says antibiotics are required the rest of my life) before any dental procedure and my dentist who says he does what the Dr. requires. I asked and he does have patients whose surgeons do NOT require antibiotics before dental visits. That’s just crazy. So before leaving the dentist without getting teeth cleaned, I asked if I could get a note from another Dr. such as my family physician and they said that would be fine. It’s all about fear of lawsuits in my opinion. The docs fear (however tiny the chance ) a lawsuit about an infection, and they aren’t worried about a lawsuit from possible side effects or long term problems from unnecessary antibiotics. Next time I go to the dentist, I might just lie and tell them I’ve taken my antibiotics. What a stupid world ignoring the science in front of our faces. I’ve read other studies that say antibiotics are not indicated and may in fact do more harm than good in the long run.

I’m in the UK , had a TKR and lots of dental issues so I am researching. The dental association here is against the antibiotic use due to risks of resistance should you get an actual infection. The research appears to hold out this theory, yet in other countries the surgeons and some dentists are insisting on antibiotics and as per some comments, there are people with joint replacements who have had bad experience they have been told due to not having the antibiotics and the dental bacteria setting in the prosthetic. I am an ex health professional so I understand that over use of abx is a serious issue. But it is also disturbing to be a joint replacement patient with gum and teeth problems. It begs the question whether the supposed infections of prosthetics with mouth bacteria have been accurately recorded. Has the research so far just not happened to find a correlation of any significance? Are the surgeons and others insisting on abx before dental procedures unaware of the more recent guidelines, or just covering their backs in case of being sued? In the UK the NHS means the surgeons are covered if they adhere to the current recommendations of course. I understand that just brushing your teeth or eating crunchy food is similar in many ways to having a dental clean, so you could be exposed anyway on a daily basis. But what about extractions? I’m wishing I had not had a TKR in a way, but the natural joint was in terrible shape, painful and locked, I’m feeling like we have a potential time bomb in our bodies and it is not a nice thought. Lets hope that some firmer conclusions can be made soon.

thanks, i was told to take them. its ben 3 1/2 years and the above makes sense. My former surgeon said he did not know latest as i am sure as not to implicate himself now that he is retired like me. Appreciate you above advice. Makes sense.
Thx. M Merc.

Interesting reading and may I add experience from New Zealand. Had two full hip replacements [3 years apart] and after both, within a year went to Thailand for a holiday which both times included several full crowns of dental work. At no time did the Thai dentist ask me to take caution for possible ‘mouth – hip’ related infection. Also in NZ for dental work no questions ever asked. So I was oblivious to this issue until now. By the way I have no problems with either hip. From memory my hip surgeon informed me that any infection would most likely originate from the time of the operation, hence special attention to pre and op hygiene. In general our countries medical philosophy is to keep antibiotic use to a minimum to try to stop the potential for super bugs.

Very helpful information. I recently contracted c-diff after taking an extended dose of clindomyacin . As you are aware C-Diff is not a very nice bacteria.
Personally I learned more about this bacteria than I ever wanted to. As
mentioned routein antibiotics before dental procedures if you’ve had a total joint
replacement are probably not warranted.

I am a retired dentist and have been interested in this topic for many years. If there was any evidence that antibiotics actually PREVENT infections…then maybe it’s worth debating. Most antibiotics work by limiting cell wall formation when bacteria are in the log phase of growth. They DON’T kill fully formed bacteria. It’s just hard to imagine that they “prevent” anything. I have yet to see a case in the literature where it is proven that a joint infection occurred secondary to dental treatment. If this was truly an issue every patient who has an artificial joint and also brushes their teeth would be at risk and there would be an epidemic of joint infections, eh? It’s a recommendation that is not grounded in science at all. If there was a problem with joint infections following dental work it would be abundantly clear by now. Just the fact that no one can find any conclusive evidence for these infections would seem to indicate it is a vanishingly rare occurrence. Yes, there may be some outliers but the chance of severe side actions from antibiotics is clearly FAR higher. From anaphylaxis to gastric ulcer to disruption of the gut microbiome and C.Diff infection-antibiotics are WELL-KNOWN to cause a plethora of problems in many patients. So choose well…..

I have had knee replacement surgery 3 times on my left and 2 times on my right. I was told that I did not need antibiotics prior to having dental done. I had a teeth cleaning and ended up in the hospital with a 103.5 degree temp. The Doc. said it was probably from the cleaning. They gave me antibiotic and it took about 5 hour for my temp. to get to 99.

I only use antibiotics for dental visits. That is twice each year for cleaning. My opinion is, it is better to be safe than sorry.
Taking these antibiotics only twice each year is not causing any major antibiotic-resistance…….

Had a big “to do” with periodontist this morning. After waiting 45 minutes for her, she asked: “pre medicate?” I said : “No it’s been 3 years since my knee replacement” to which she stated that if I got infected I would sue her…I think she was worried about her own neck and no regard for the negative effects of the antibiotic on my system. She now claims it should be 5 to 7 years for “medicating”. She sent me for lunch and hour wait after providing the antibiotic. My surgeon’s office finally called and said “not necessary” after the meds were taken, I waited the 2nd 45 minutes and the procedure completed….stressed from all this waiting and unnecessary meds in my system.

Have decided after reading this article I will no longer take antibiotics pre dental treatment even though I have 2 hips and 2 knees replaced…last knee March 2 2018 was given a pre antibiotic before knee had a GI dirreha for 4 months……

In 1976 I was injured in a car crash, resulting in a broken hip. I underwent 3 surgeries through the years, followed by a total hip replacement and most recently (1987) had a revision of my hip to cure a severe infection. I have been taking antibiotics one hour before any dental treatment since day one. Now I have a new doctor who tells me: my “past hip replacement does not require an antibiotic per current guidelines.” I have a dental appointment tomorrow and no antibiotics; Maybe my dentist will supply the meds. Color me anxious.

Hello: Has there been and current studies about taking antibiotics for dental work or people with artificial joint? I have a knee support group for people all over the world. I have over 900 members and this is a huge debate and concern. Yes, take antibiotics or No, don’t take them. What are the odds of getting an infection in the joint? Have these infection been reported at all? I need to find answers to help my members. Can you help please? Thank you!

My husband cut his finger with a knife 7 days ago. He had to go to the emergency room for stitches, he could not get the finger to stop bleeding. The stitches helped stop the bleeding as well as pressure on the wound. He used a topical antibiotic on the wound. He had his right hip replaced 8 months before this. Should the emergency room doctor have prescribed an antibiotic for him? He said there was no need as it looked like a clean cut. Five to six days later he is having some pain/soreness in his lower back. Should we be afraid of an infection causing the back pain?

I have a total hip replacement & been taking for the last year or more, 4 pills, 500 mg each of amoxicillin every 3 months while going to the dentist for cleanings. After reading the info I have decided to stop taking the antibiotics. How much damage to my body have I caused by taking these antibiotics?
Thank you
Very Concerned

Since my surgeons are orthopedic/joint specialists, I think I will listen to them and be safe and take the antibiotics. Joint replacement surgery is not a walk in the park. It involves a lot of care and healing time. Cleanliness and sanitary care are VERY important before, during AND after surgery. I have had joint replacement surgeries and my primary doctor, surgeons, and dentist all agree and insist antibiotics be taken before certain procedures

Well I’m just a person looking for advice before knee replacements as I need both. I’ll read a lot of articles on the antibiotics subject and also saw what the pharmaceuticals did to my daughter after thirteen years and then found out she was miss diagnosed! Then I read about different bacteria becoming resistant to different antibiotics!?!?!?
And does the FDA or BIG PHARMA really CARE???ONLY ABOUT $$$!?!?!?

That really tell me I sure not take antibiotics? If you had as many as I have totally knee replacement & I not even talking about my 2 fusion operations? You have as many operation I have? I rather be safe? Also my doctor said if you bust or infect your back? You wish you never had because it way worst then the first operation & let me tell you I had 4 totally knees operation & I rather have a hundred knee replacement then go threw back surgery ever again? One last thing is it smart to listen to A Dentist about back & hip & knee replacement infection? Because if they are cutting in your mouth & say the knife is not real clean? Can you not get a infection by dirty knife that dentist use to make cuts? I know dentist are very careful but people can make mistakes & I’m sure cutting with a knife in your mouth would get your blood stream? Can that give you a infection to your back & knees if the knife is dirty? That’s is what worries me most because a lot of people need to touch that knife from cleaning it? Then placing it in the bag & ceiling? Then when it’s first open always before your procedure? So that is what worries me most? The tools they cut & poke & drill? Like I said? If you had as many operations as I have? You do not want anymore & specially if you have to have a knee replacement & back fusions again back to back because they can not wait long to get the infection out? Two weeks after my knee,then my back & that would be real tough? If you could get me a answer about the tools making cuts in your mouth if they are infected? Could that infect your totally knee & back? That is one I really need to know? Thank You! Rick & accuse my mistakes?

I have a dentist appointment for a root canal. I had to take 2 300mg tablets of clyndamycin and within 15 minutes had very bad heartburn and my mouth was watering much more then normal is this normal and is there any other antibiotic that I can use? I am allergic to penicillin,

I had knee replacement in 2015 and found out the implant is lose. Some dentis recmend the antibiotics the other won’t , which one is right? Since I already have problem with the lose implant I am extra conscious. After reading the article, it seems like I should not be taking the antibiotics
Thank you.

Sorry folks. I am the one with the TKA. Only ZERO risk is ok with me. I am the one who would have to undergo two more hellish procedures to correct the mess. Talk to the ortho surgeons about what it takes to clean up thw mess and how long the patient will be disabled. When you have a bunch of panelists who have undergone TKA tell me they themselves dont bother with prophylactic ab, lets hear from you again. Lets hear from someone with skin in the game, not some scientists debating hypotheticals

I don’t know what to do my hip replacement is now 4mos old and now I have a bad took that need to be remove and I was told I have to call orthopedic doctor to get antibiotics before I have the tooth extracted please someone help I woke up this morning with my face swole that is a sign of an abscess what should I do help help help

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